Ask the Expert: Total Joint Replacement

ASK THE EXPERT: Nakul Karkare, Orthopedic Surgeon, St. Charles Hospital

Adults between the ages of 46 and 62 are living more active lifestyles than their parents did at the same age. However these baby boomers face the same challenges that come with aging, including arthritic degeneration of their joints. More than simply a bum knee or a sore hip, degenerative joint disease (DJD) is the most common reason doctors recommend total joint replacement surgery for their patients. And while baby boomers may fear that a brand new knee or hip will slow them down, modern medical advances are giving them reason to hope for a faster, more complete recovery than their parents were offered. To better understand the latest improvements to this life-changing surgery, we sat down with Nakul Karkare, an orthopedic surgeon at St. Charles Hospital. Dr.Karkare is fellowship trained in total joint replacement, trauma, and metabolic bone disease. He brings his expertise to St. Charles Hospital, where surgeons perform more than 1,000 orthopedic procedures annually - more than any other hospital in Suffolk County.

Question: What do you tell your patients about total joint replacement surgery?

Dr. Karkare: With the latest advances in treatment, implants, and minimally invasive operative techniques, total joint replacement can be one of the most satisfying surgeries of modern times. The goals of the procedure are straight-forward: relieve pain, restore motion, and get patients back to their favorite activities.

Question: Is surgery always the first option?

Dr. Karkare: No. Before examining surgical options, I exhaust all non-surgical approaches for temporary relief from joint pain. These include a healthy diet, regular exercise, and over the counter pain medications, such as ibuprofen and acetaminophen. Steroid injections can also be helpful but physicians often limit the number of injections an individual receives. I do not recommend the use of over-the-counter nutritional supplements, including glucosamine and chondroitin. They are not regulated by the US. Food and Drug Administration and are sold with limited or no research on how well they work. These supplements can also influence blood sugar and lead to upset stomach.  Glucosamine can induce an allergic reaction if the patient is allergic to shellfish.

Question: How do you determine if patients are candidates for total joint replacement?

Dr. Karkare: As part of a larger diagnostic process, I use three criteria. If my patients meet all three, I suggest that they consider total joint replacement. First, I consider if joint pain has limited daily mobility so much that a patient can no longer perform even the most basic of tasks, such as climbing stairs or stepping in and out of the tub. Then, I examine the painful knee or hip for range of motion and shape, as well as observe the patient’s gait, or manner of walking. Finally, I review diagnostic imaging results to determine if a patient suffers from arthritic degeneration of the joint. Only if all three are checked off, I consider a candidate for surgery.

Question:  What can a patient do to prepare for total joint replacement?

Dr. Karkare: Generally speaking, surgical candidates can remain active until their surgery. Inactivity can further limit muscle mobility and compound an existing condition. While patients are waiting for joint replacement surgery, I encourage them to remain active. Swimming is an excellent option to maintain muscle bulk and joint flexibility. It offloads the body weight while exercising. Patients who are unable to swim can benefit from water exercises alone. They do not need to necessarily swim. I advise against the use of prescription pain pills at this point since they can be addictive and could make post-surgical pain control a problem.

Question:  What are some of the surgical options available?

Dr. Karkare: Modern, minimally invasive surgical techniques are exciting because they offer faster recuperation and better maintenance of individual walking patterns. In standard hip replacement, a surgeon approaches the joint from the front, which requires muscles to be cut. However, there is growing consensus around the use of an anterior approach which involves accessing the joint from behind. A smaller incision is made and, under normal conditions, surgeons do not need to cut muscles. This reduces overall muscle disruption and may even reduce recovery time. With this approach, I have seen patients who are pain free in a very short time. Many resume walking quickly and have good strength. Also, implants made from a combination of plastic and ceramic offer patients better benefits than implants developed in the past. Today’s implants provide a more customized feel because they match natural anatomy better, resist wear and tear, and give an improved range of motion and decreased risk of joint dislocation.

Question: What can patients do after total joint replacement surgery to help achieve optimal joint mobility?

Dr. Karkare: Physical therapy is very important. With knee replacement, it is absolutely critical for patients to be proactive with their physical therapy. Generally speaking, the range of motion a knee replacement patient achieves within the first three months is likely the range of motion they will have for the rest of their lives. Hip replacement patients typically achieve an impressive range of motion due to the structure of the hip joint.

St. Charles Hospital is the area’s premier center for the treatment and rehabilitation of orthopedic problems. Specially-trained surgeons perform more than 1,000 orthopedic procedures annually - more than any other hospital in Suffolk County. St. Charles provides the most progressive orthopedic treatment available today including computer-assisted, minimally invasive surgery for hip and knee replacement and lumbar spine, arthroscopic surgery for rotator cuff tears, ankle injuries, elbow and wrist disorders and ACL reconstruction. Comprehensive rehabilitation programs are offered through St. Charles Rehabilitation’s inpatient and outpatient rehabilitation programs, the only rehab facility on Long Island with CARF accreditation for both the inpatient and outpatient programs. To learn more about orthopedic or rehabilitation services at St. Charles, please call (631) 474-6797.